Pyogenic spondylitis and early tuberculous spondylitis in children: differential diagnosis with standard radiographs and computed tomography.

In a study of 23 patients, axial computed tomography (CT) was the most valuable modality to differentiate between early tuberculous (10 patients) and pyogenic spondylitis (13 patients). Tuberculous spondylitis showed large erosions with calcification, whereas pyogenic spondylitis showed multiple small well-defined erosions, mostly without calcification. Both groups had large or small paravertebral soft tissue swelling, with accompanying calcification, in six of the 10 patients with tuberculous spondylitis and in only one patient with pyogenic spondylitis. Tuberculous spondylitis showed larger intraspinal extradural abscesses, with calcification in 50% of cases, whereas pyogenic spondylitis demonstrated no calcification.